Sequential Outcomes following Total Knee Arthroplasty

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Sequential Improvement In

Clinical Outcomes Post TKA

BA Rogers, L Unitt, SR Cannon, TWR Briggs

The Balancer Study Group

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Intro� Numerous studies highlight

 ± outcome

 ± function

� variety of measures/scores

� medium term (3 & 5 year studies)

� long term (5 years +)

� Few show progressive outcome profile of a cohort

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Aim� Assess  sequential change in knee outcome

& function in a cohort of patients

undergoing TKA

� Assess the differential outcome profile

depending on the degree on initial

functional impairment

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Methods

� Prospective, multi-centre study

� cemented TKA (Kinemax)

� 526 knees

� Indications OA and RA

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Methods

� Patient assessment

 ± Pre-op

 ± 12 months, 2 years & 3 years

� Oxford Knee Score (60 worse, 0 best)

� Knee Society Score (0 ± 100)

� Functional score (0-100)� Range of knee flexion

� Data analysis ± unpaired, 2 tailed T test, SPSS

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Methods

� Pre Op to 1 year change

� Profile for 3 years post op

� Patients categorized into 3 groups� Group 1

 ± OKS 13 ± 37 «««.MODERATE

� Group 2

 ± OKS 38 ± 47 «««..POOR 

� Group 3

 ± OKS 47 ± 60««««SEVERE

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Results� GROUP 1«««.MODERATE

 ± N=112

 ± Age 70.57yrs (53-84 yrs)� GROUP 2«««..POOR 

 ± N=267

 ± Age 69.48yrs (40 ± 88 yrs)

� GROUP 3 «««.SEVERE ± N=147

 ± Age 69.87yrs (40-90 yrs)

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Oxford Knee Score

0

10

20

30

40

50

60

preop 1 yr 2 yr 3 yr  

Assessment

      S     c     o     r     e

Group 1

Group 2

Group 3

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Oxford Knee Score

Pre-op to 1 year Improvement in Oxford Knee Score

0.00

5.00

10.00

15.00

20.00

25.00

30.00

roup 1 roup 2 roup 3

OKS categories

   I  m  p  r  o  v  e  m  e  n   t   i  n   O   K

   S

 p<0.05

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Knee Society Score

Sequential Knee Society Score

0

20

40

60

80

100

preop 1 yr 2 yr 3 yr  

Assessment

      S     c     o     r     e Group 1

Group 2

Group 3

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Knee Society Score

Preop - 1 year improvement in Knee Society Score

0.00

10.00

20.00

30.00

40.00

50.00

60.00

Gr   1 Gr   2 Gr   3

OKS categories

   I  m

  p  r  o  v  e  m  e  n   t   i  n   K   S

   S p>0.05

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Flexion

Sequential Range of Movement

80

85

90

95

100105

110

preop 1 yr 2 yr 3 yr  

Assessment

      D     e     g     r     e     e      s Group 1

Group 2

Group 3

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Pr   t 1 y r impr  m t i M m t

0

2

4

6

8

10

12

14

Gr   1 Gr   2 Gr   

      D

     g  r

Flexion

P=0.08

P=0.17

P=0.0004

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Discussion

Oxford Knee Score

� All groups improved

� Severe knee s ± improve the most (p<0.05) @ 1 year 

 ± show no further improvement @ 2 -3 yrs

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Discussion

Knee Society Score

� All groups improved

 ± improvement similar (p>0.05) @ 1 year in all groups ± show no further improvement @ 2 -3 yrs

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� Most improvement in severe knees (p<0.05)

� Suggestion of deterioration from 2 ± 3 yrs ± 

 but not statistically significant

Discussion

Range of Movement

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1) Comparing mild to severe pre-operative knees:

May be  significant difference in functional

Improvement (Oxford Knee Score)««

«..but no difference in clinical improvement

(KSS and range of movement)

2) Is continued improvement limited to 2-3 years ?

Conclusion

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Thank You